Aberrant Right Vertebral Artery From Descending Thoracic Aorta

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Aberrant Right Vertebral Artery From Descending Thoracic Aorta Shivaprasad Babu Mukkannavar, MS, Mch, Sachin Anant Kuthe, MS, Mch, Anand Kumar Mishra, MS, Mch, Manoj Kumar Rohit, MS, Mch The Annals of Thoracic Surgery Volume 96, Issue 3, Pages 1074-1076 (September 2013) DOI: 10.1016/j.athoracsur.2013.01.043 Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) Aortic angiogram in right anterior oblique-caudal view showing the aortic arch branches and anomalous RSA and RVA from proximal DTA. (B) The course of anomalous origin of the RVA is visualized in left anterior oblique-cranial view. *RVA originating distal to the anomalous RSA and LSA. **Anomalous origin of the RSA from the proximal DTA. (DTA = descending thoracic aorta; LSA = left subclavian artery; RSA = right subclavian artery; RVA = right vertebral artery.) The Annals of Thoracic Surgery 2013 96, 1074-1076DOI: (10.1016/j.athoracsur.2013.01.043) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Normal development of third and fourth aortic arch and bilateral subclavian arteries and vertebral arteries. The RSA originates from the primitive right dorsal aorta and is a continuation of the seventh CISA. The RVA is derived from the proximal part of the dorsal branch of the seventh CISA and longitudinal union of postcostal anastomosis between one to seven cervical intersegmental arteries. The caudal part of the right dorsal aorta near the confluence with the left dorsal aorta is usually obliterated. (CISA = cervical intersegmental artery; LCCA = left common carotid artery; LSA = left subclavian artery; LVA= left vertebral artery; RCCA = right common carotid artery; RSA = right subclavian artery; RVA = right vertebral artery.) The Annals of Thoracic Surgery 2013 96, 1074-1076DOI: (10.1016/j.athoracsur.2013.01.043) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Schematic diagram of embryologic development of anomalous RSA and RVA. The right dorsal aorta is obliterated more proximally (i.e., proximal to the seventh CISA). The RSA origin is shifted to the left, originating from the distal arch or proximal DTA. The persistent eighth CISA combined with a longitudinal union between one to eight CISAs will give rise to the abnormal origin of RVA. As a result, the RVA originates from the proximal DTA (i.e. distal to the origin of LSA and anomalous RSA). (CISA = cervical intersegmental artery; DTA = descending thoracic aorta; LCCA = left common carotid artery; LSA = left subclavian artery; LVA = left vertebral artery; RCCA = right common carotid artery; RSA = right subclavian artery; RVA = right vertebral artery.) The Annals of Thoracic Surgery 2013 96, 1074-1076DOI: (10.1016/j.athoracsur.2013.01.043) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions